全数字化钼靶X线摄影在乳腺癌诊断中误漏诊分析

Analyses of Misdiagnosis and Missed Diagnosis in Patients with Breast Cancer by Full Digital Mammography

目的:探讨乳腺癌在全数字化钼靶X线摄影诊断中误漏诊原因,提高乳腺癌的钼靶X线诊断率。方法:收集2016-2017年行全数字化钼靶X线摄影并经手术病理证实的乳腺癌患者675例,回顾性分析首次钼靶X线中存在误漏诊的75例病例,误漏诊率为11.1%。结果:450例浸润性导管癌误漏诊41例,误漏诊率9.1%;158例导管原位癌误漏诊22例,误漏诊率13.9%;18例混合癌误漏诊3例,误漏诊率16.7%;49例导管内乳头状癌误漏诊9例,误漏诊率18.3%。其中不均匀致密类、极度致密类乳腺实质及星芒状结构扭曲误漏诊率较高,脂肪类诊断准确率最高。结论:在读片中出现乳腺实质为不均匀致密类、极度致密类患者时,应该尽量调低亮度、增强对比度,仔细观察双侧乳腺寻找不对称性差异,根据BI-RADS分类进行诊断,可以有效降低误漏诊率。

Objective:To investigate the causes of misdiagnosis and missed diagnosis of breast cancer in full digital mammography,and to improve the diagnostic rate of breast cancer by mammography.Methods:675 cases of breast cancer confirmed by operation and pathology were collected during 2016-2017.75 cases of misdiagnosis and missed diagnosis in the first molybdenum target X-ray were retrospectively analyzed.The misdiagnosis and missed diagnosis rate was 11.1%.Results:41 cases of invasive ductal carcinoma were misdiagnosed,accounting for 9.1%of the misdiagnosis rate;22 cases of 158 cases of ductal carcinoma in situ,accounting for 13.9%of the misdiagnosis rate;3 cases of mixed cancer,accounting for 16.7%of the misdiagnosis rate;9 cases of 49 cases of intraductal papillary carcinoma,accounting for 18.3%of the misdiagnosis rate.Among them,the misdiagnosis rate of non-uniform dense breast,extremely dense breast parenchyma and star-awn structure distortion is higher,and the accuracy rate of fat diagnosis is the highest.Conclusions:When patients with non-uniform and extremely dense breast parenchyma appear in the reading film,the brightness should be lowered and the contrast should be enhanced as far as possible.Careful observation of bilateral breast to find out the difference of asymmetry can effectively reduce the rate of misdiagnosis and missed diagnosis according to BI-RADS classification.